Tennis Elbow and Golfer’s Elbow
Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) are both conditions that occur as a result of inflammation at the insertion point of a tendon into a bone. Tennis elbow affects the inside of the elbow while golfer’s elbow occurs on the outside of it.
Despite their names, these are not conditions experienced exclusively by tennis players and golfers! Most people develop one of these conditions following an increased period of strenuous activity involving the muscles of the forearm; gardening or twisting and gripping a screwdriver when carrying out some DIY around the house, for example.
Nobody understands your pain and the effect it is having on you better than you. When we meet for a consultation, I will talk with you about your symptoms, when they came on and whether you have tried any treatments up to this point.
For both conditions, localised pain is felt in the elbow. In practice, this means that people with tennis elbow will feel pain or tenderness on the inside of their elbow while those with golfer's elbow will feel it on the outside.
Both conditions tend to develop over time. The tendons become inflamed and painful, usually because you have used the muscles in your forearm and upper arm more than you are used to. Other times, small tears can develop in the tendon over time, gradually becoming worse.
Usually, people feel pain at a specific point in the elbow; either the outside or the inside. They may notice it starts to hurt when they pick up a shopping bag or lift a chair from the floor. Sometimes, even small things like clicking a button on a computer mouse or typing on a laptop can set off the pain.
From my experience, many people seem to struggle on a little bit with their elbow pain, hoping it will resolve itself naturally. While this can happen, often people will realise they need to see me when the pain reaches a certain level or has been going on for a period of time.
In terms of diagnosing golfer's elbow and tennis elbow, I would expect my clinical examination to show tenderness over the specific tendon.
There are some additional tests I can carry out, such as resisted finger extension tests and resisted wrist extension tests. These can be very helpful in giving me a good understanding of the cause of your pain and the extent of the problem.
Sometime, the diagnosis is not clear from a clinical examination and I would then arrange additional diagnostic tests through either an ultrasound or MRI scan. Both of these can show changes in, or damage to, the tendon, giving me the ability to confirm a diagnosis.
There are different treatment options available, and I will work with you to ensure you receive the one most suitable for you and your needs. Two are conservative (non-surgical) treatments and one is surgical.
- Physiotherapy: When done properly, physiotherapy has been shown to be quite effective, often resulting in longer-term pain relief. Along with certain exercises, the physiotherapist may also prescribe or fit you with a tennis elbow brace, which is a bit like having a pressure point strapped onto the tendonitis. It stabilizes the tendonitis and usually helps with pain relief.
- Cortisone injection: In cases where physiotherapy has been tried but has not been as effective as required, or when a patient needs pain relief as quickly as possible, I can inject the tendon with cortisone and local anesthetic. This can be a good way of getting pain controlled quickly. The cortisone has an anti-inflammatory effect.
- Surgery: Most people I treat for golfer's elbow or tennis elbow find that conservative treatment works well. Only very few people will need surgery to treat these conditions. The surgical treatment is carried out under general anaesthetic and involves releasing the tendon from the bone. It's a broad tendon so only a part of it is released. This means that you won't have any reduction in strength after surgery. Following your surgery, we will wait around 3-4 weeks before starting you on some stretching exercises. We don't start the stretching earlier because we want to allow the tendon to heal back onto the bone. Range of motion exercises are allowed from day one, but the strengthening exercises start later.
As a consultant who specialises exclusively in problems of the hand and wrist, I have helped a lot of people with golfer's elbow or tennis elbow to successfully recover and to live free of pain once again.
If you would appreciate a consultation with me to discuss suitable treatment options, why not book a consultation with me here at Circle? Just contact my private secretary who will be delighted to book you in for a day and time that is most convenient for you.
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